This invention relates to a gastrointestinal feeding and aspirating device and a method of use in treating patients.
Post-operatively, gastrointestinal functions usually deteriorate. The causes of this deterioration are varied and include such factors as the use of anesthesia or pain killing drugs, and the handling of the bowel during the operation. Additionally, air swallowed by the patient contributes to gastrointestinal malfunctions since the gas is inefficiently propelled through the digestive tract. This causes a problem commonly known as abdominal distention which not only impairs bowel function and interferes with the rate of absorption of nutrients through the bowel, but often prevents the patient from breathing deeply or coughing, which can lead to severe pulmonary difficulties. In severe cases, the pressure caused by the abdominal distention has been known to break open the patient's wound. One of the indirect effects of abdominal distention is the fact that due to the pain associated with it, and the lesser rate of bowel absorption, the patient often becomes undernourished which slows the healing process. It has, therefore, been a long-standing objective of the medical profession to prevent abdominal distention while providing sufficient nutrition in order to speed the patient's recovery.
One device which has been successful in handling these difficulties is a naso-esophago-gastric decompression tube with a duodenal feeding tube. I developed this nasal tube a number of years ago, and it is still available under my trademark G. MOSS, said tube being manufactured by National Catheter Company. This device has a number of aspirating orifices at the distal end of the esophagus. This is a very effective place to remove air since that passage is a small diameter conduit through which all the air must pass. While this naso-gastric tube has proved to be quite successful, there are a number of operations wherein a nasal tube cannot be used. Also, for various reasons, certain patients are unable to use a nasal tube.
When the nasal passageways cannot be used, an aspirating tube can be inserted directly through the abdominal wall and into the stomach. However, several difficulties are encountered when trying to aspirate the stomach. First, the stomach contains phlegm, which has a tendency to accumulate in the aspirating tube and the tube orifices causing blockages. Second, the stomach, when functioning, forms folds such that matter introduced into the stomach is divided and transported across the stomach within separate passageways. Since an aspirating orifice within the stomach can only lie within a single passageway, the aspiration is limited to matter passing through that passageway. Therefore, it is common for matter to bypass the aspirating orifices and proceed further along the digestive tract causing distention.
In addition to aspirating postoperatively, it is also important that the patient be provided with a sufficient amount of nutrition. This can be accomplished by passing a feeding lumen through the stomach and the pyloric sphincter into the proximal segment of the small bowel. A feeding solution introduced through the lumen will enter the proximal segment of the small bowel and be directed downstream through peristaltic action. When feeding a patient in this manner, the normal food paths are bypassed; thus, also avoiding the safeguards which warn of fullness. Therefore, one administering a solution in this manner must be aware of the possibility of overloading the small bowel. The possibility of overfeeding is increased when the malfunctioning gastrointestinal system affects the peristaltic action of the small bowel. The lack of peristaltic action prevents the downstream flow of food such that the feeding solution being introduced builds pressure within the bowel.
My first response to these difficulties was to use a gastrointestinal tube inserted through the abdominal wall which would work in a similar manner to my nasal tube. This involved directing the aspirating lumen up from the stomach to the distal end of the esophagus; thus, taking advantage of the small diameter conduit as had been done with the nasal tube. I soon found, however, that there was no practical way of securing the device in the needed position. While working on alternate methods to effect more complete aspirations, I realized that aspirating the proximal segment of the small bowel could serve a dual purpose when properly combined with a stomach aspirator. Since the proximal segment of the small bowel is also a small diameter conduit, most of the matter entering from the stomach would be aspirated. Additionally, when I used a single lumen with aspirating orifices in both the stomach and the proximal segment of the small bowel, I was able to take advantage of the natural digestive juices in the small bowel to dissolve the phlegm being aspirated upstream in the stomach. Thus, I was able to provide the additional aspiration needed to pick up matter missed in the stomach while also taking advantage of the body's own digestive juices to maintain the lumen free from blockages.
Aspirating the proximal segment of the small bowel also became an important aspect for the avoidance of overfeeding. My first experiments with this involved inserting two tubes through the stomach and the pyloric sphincter into the proximal segment of the small bowel, one tube for aspirating and the other for feeding. I positioned the feeding tube so that the feeding site would be downstream of the aspirating site. Since both the feeding and the aspiration were occurring beyond the pyloric sphincter, I found that any excess feeding solution could now flow quite easily retrograde and be aspirated. This not only prevents overfeeding, but it also warns the person administering that the bowel is not handling the feeding solution, so that he can regulate the rate accordingly.
It is, therefore, an object of this invention to provide an aspirating device which is effective in avoiding abdominal distention.
It is also an object of the invention to provide a device which is less subject to clogging than prior devices.
It is yet another object of this invention to provide a feeding and aspirating device which prevents overfeeding.
Briefly described, this invention consists of a tube having a feeding lumen and an aspirating lumen which are inserted into the patient's body and secured thereto. Both the aspirating lumen and the feeding lumen have orifices so as to communicate with various sites within the patient's body. When in its secured position, the feeding orifice is positioned in the proximal segment of the small bowel. Upstream from the feeding orifice, and before the pyloric sphincter, at least one aspirating orifice also communicates with the proximal segment of the small bowel. In the stomach, the same aspirating lumen has at least one additional orifice for aspirating the stomach.
In an alternate embodiment, the above invention has an additional lumen which has orifices therein which communicate solely with the stomach. This lumen acts as an additional source of aspiration for the stomach cavity and allows for the aspiration of that cavity without aspirating the proximal segment of the small bowel.